Predicting Nasal High-Flow Treatment Success in Newborn Infants with Respiratory Distress Cared for in Non-Tertiary Hospitals

Abstract

OBJECTIVE: To evaluate demographic and clinical variables as predictors of nasal high-flow treatment success in newborn infants with respiratory distress cared for in Australian non-tertiary special care nurseries (SCNs). STUDY DESIGN: A secondary analysis of the HUNTER trial, a multicentre, randomized controlled trial evaluating nHF as primary respiratory support for newborn infants, born ≥31 weeks' gestation and had a birth weight ≥1200g, with respiratory distress, cared for in Australian non-tertiary SCNs, was performed. Treatment success within 72 hours after randomization to nHF was determined using objective criteria. Univariable screening and multivariable analysis was used to determine predictors of nHF treatment success. RESULTS: Infants (n =363) randomized to nHF in HUNTER were included in the analysis; mean (standard deviation) gestational age was 36.9 (2.7) weeks and birth weight 2928 (782) grams. Of these, 290 ( 80%) experienced nHF treatment success. On multivariable analysis, nHF treatment success was predicted by higher gestational age and lower fraction of inspired oxygen immediately prior to randomization, but not strongly. The final model was found to have an area under the curve of 0.65, which after adjustment for optimism was found to be 0.63 (95% confidence interval: 0.57-0.70). CONCLUSION: Gestational age and supplemental oxygen requirement may be used to guide decisions regarding the most appropriate initial respiratory support for newborn infants in non-tertiary SCNs. Further prospective research is required to better identify which infants are most likely to be successfully treated with nHF.